More Anemia Screening Needed?

Iron deficiency is reported to affect 60 percent of female athletes in the United States. As alarming as that statistic may be, it seems most NCAA Division I institutions have a ways to go in detecting and treating the condition.

In a recent study, an anonymous online survey was sent to 94 Division I schools to determine current practices in regard to screening and treating athletes for iron deficiency. Only 43 percent of the 54 respondents indicated that their institutions screened for iron deficiency in female athletes.

"We found that there really wasn’t anything consistent," says Chris Rosenbloom, Nutrition Consultant for the Georgia Tech athletic department, an Associate Professor at Georgia State University, and one of the study’s authors. "Across the board there were many differences—a lot of schools weren’t testing, and those that were testing were only testing women. Some were testing all female athletes, some were just testing freshmen, and some were testing but not following up. And different schools were using different cutoff values for what they defined as anemia."

Rosenbloom believes all athletes should be tested at least once a year. "And it would be wise not to do just hemoglobin and hematocrit tests, but also to look at their iron and ferritin levels," she says.

Female athletes—especially those competing in track and field’s endurance events—are particularly at risk, says Rosenbloom, because they usually are more restrictive with their diets and may not get a lot of iron-rich foods. "A lot of female athletes are vegetarian or semi-vegetarian," she says, "which cuts out a lot of good iron sources."

One common misconception among athletes is that because iron is found in grains, breads, and cereals, those sources provide adequate amounts to satisfy a vegetarian diet. "You have to make sure that if you are eating iron-fortified grains, you are also getting a good vitamin C source to help with absorption," says Rosenbloom. "There are things that an athlete can do to make a vegetarian diet work, but it makes it a lot harder."

The amount and type of training done by endurance athletes puts them at greater risk of iron deficiency. "Foot-strike hemolysis—which comes from all that pounding on the pavement—can cause minor losses of blood because as blood travels through the foot, the compression can break up some of the red blood cells," says Rosenbloom. "Over time, with the mileage they put in, that really adds up."

Plus, Rosenbloom notes, all athletes lose some iron in sweat. And when athletes take a lot of over-the-counter anti-inflammatory medications like Ibuprofen or aspirin, those drugs can cause minor gastrointestinal blood loss. "When you add all those things up, you can have an athlete who has iron deficiency anemia or iron deficiency without anemia," says Rosenbloom.

There are also some misconceptions about how beneficial iron supplements are for people who are iron-depleted, but not yet iron-deficient. "My philosophy is that if you know someone is already iron-depleted, have them take iron supplements to prevent a true deficiency," says Rosenbloom. "But coaches and athletic trainers should avoid promising the athlete that just because they take an iron supplement, they are going to dramatically improve their performance right away. Iron deficiency does not occur overnight, and the remedies also take time."